Provider Demographics
NPI:1831218494
Name:BROTH, STUART A (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:BROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 WICKLOW LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1328
Mailing Address - Country:US
Mailing Address - Phone:804-276-5060
Mailing Address - Fax:804-276-5061
Practice Address - Street 1:3400 WICKLOW LN
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-1328
Practice Address - Country:US
Practice Address - Phone:804-276-5060
Practice Address - Fax:804-276-5061
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401008293OtherDENTAL LICENSE NUMBER